Senior Analyst, Credentialing Data Operations

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Execute intricate operational tasks related to credentialing, provider data, quality assurance, and analytics in alignment with relevant requirements, policies, procedures, and service-level expectations.

• Assess practitioner and facility credentialing records, workflows, source documentation, and system data for accuracy, completeness, timeliness, consistency, and compliance.

• Analyze extensive or complicated datasets utilizing spreadsheets, reporting tools, database queries, or other analytical methods to evaluate quality, productivity, timeliness, inventory, and operational performance.

• Develop, maintain, and validate reports, dashboards, metrics, and monitoring controls.

• Investigate data discrepancies and reconcile information across systems or authoritative sources.

• Conduct root-cause analysis and interpret audit findings, data trends, and operational insights into corrective and preventive measures, process enhancements, and quantifiable recommendations.

• Lead or assist in resolving intricate quality, data, or credentialing challenges; monitor action plans until resolution and verify corrective actions.

• Mentor team members and provide subject-matter expertise.

• Independently manage assigned projects, analyses, audits, escalations, and caseloads.

• Adhere to all applicable laws and regulations.

• Report to the Senior Manager of Provider Operations Credentialing.

⛳️ Requirements

• Over 3 years of pertinent experience in healthcare operations, credentialing, quality assurance or audit, provider data, data analysis, or a related field.

• Proven ability to evaluate end-to-end processes, identify risks or data issues, conduct root-cause analysis, and drive initiatives to resolution.

• Intermediate proficiency with Excel or Google Sheets, including data validation, reconciliation, analysis, and effective presentation of findings.

• Exceptional attention to detail, judgment, written communication skills, and the ability to articulate complex findings to diverse audiences.

• Capacity to manage multiple priorities autonomously and collaborate effectively within a regulated, cross-functional setting.

• Demonstrated experience in analyzing operational datasets and creating reports or dashboards.

• Willingness to learn credentialing concepts and data.

• Bonus: Experience within a health plan, delegated credentialing entity, credentialing verification organization, provider organization, or other regulated healthcare environments.

• Bonus: Proficiency in SQL, BigQuery, or a comparable query language, along with experience handling large datasets, data models, visualization tools, or business-intelligence platforms.

• Bonus: Experience utilizing credentialing, provider data, workflow, ticketing, or audit-management systems.

• Bonus: Familiarity with NCQA, CMS, state, federal, and delegated-oversight requirements pertinent to credentialing operations.

• Bonus: Relevant professional certification or formal training in credentialing, healthcare quality, auditing, compliance, or data analytics.

🏝️ Benefits

• Employee benefits.

• Unlimited vacation program.

• Annual performance bonuses.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 11 paid holidays.

• Paid sick time.

• Paid parental leave.

• 401(k) plan participation.

• Life insurance.

• Disability insurance.

• Paid wellness time and reimbursements.

• Occasional travel for team meetings and company events.